Thursday, May 25, 2017

Swimming

Even as I look at these I can't believe how much Soroti has changed in the 7 years I've been here. But we have a really nice pool now. Specifically for kids. The students I sponsor have been begging again and they know this is one of the few things I'll cave on because I love to swim too. 

Well, I agreed to take them. Unfortunately there were literally a hundred kid there. Most who clearly had no idea how to swim. Terrifying!

Anyway, here are my eight. 

They all head back to boarding school on Monday. 

Wednesday, May 24, 2017

Following up

Lots of follow ups today.....
On the 8th I was in the midst of a complicated labor when a lady with a snake bite came into the clinic. She had been picking up firewood and a cobra got her on the hand. I went to see how she was doing today and here is what I found. I know it looks a bit gruesome but I'm actually ecstatic how great it looks.  I was pretty sure there was a good chance she was going to lose the finger at least and for a while I was worried about her life. But this is just routine dressings for a long time and eventually she will be back to normal! 


Then little Mary who had tetanus back in December. She is now a healthy kid. She is still the only tetanus case I have had survive. She WOULD NOT smile for me, which is really sad because she smiled all the time in the hospital (once her muscles relaxed enough that it was physically possible) but I suspect she has a really hard life. She is HIV positive and lives with her elderly grandmother who needs her to work too much to send her to school.



Lastly I stopped by the home of Esther and her baby who is two weeks old today. They are all doing fine and the grandmother reminded me that I was the one that first diagnosed her HIV. I did not remember that but I guess it was significant enough that I blogged about it. TBT...2012

Saturday, May 20, 2017

Family

When I want to be there so much it hurts....
My family grew this week and I'm on the wrong continent.  (By the way, I realized these are slightly confusing pictures, Nick and Katie had a baby, not Chip and Susan.)

Thursday, May 18, 2017

Update on Jennifer and Esther

Update on Esther and baby Jennifer. I first wrote about them on Sunday
They were discharged today (still on some valium) so I brought them back home. 

 This is Esther with her first born, Emma. He is four years old.
Grandma holding baby Jennifer surrounded by neighbor kids. 

This little peanut went home today weighing 2.25kg.

Wednesday, May 17, 2017

I had no idea when I took this job how much time I'd spend teaching. And the strange topics. Today, I taught at a parents conference. I'm perfectly well qualified for that. 
I'm just kidding. I did teach at a parenting conference but about keeping children healthy. I'm at least mildly qualified for that, I guess.


 Fever, diarrhea, and antibiotic resistance, my favorite topics.

Sunday, May 14, 2017

For my nursing friends, at least you weren't getting transfer report from me this morning. Me: "I'm bringing you this patient from Obule Health Center. She is a G2P0 in active labor.She was c-sectioned last pregnancy. I don't know when her labor started as she won't talk. Her water broke about 25 minutes ago. I don't know how dilated she is as she won't let me check. I don't know FHTs as she won't let me near her. She is mad (meaning mentally ill) and HIV positive. This pregnancy is the result of insestual rape." Nurse midwife receiving report: ".............." Me: "Which doctor is on today?" Her: "No doctors currently on duty." Me: ".............."



So, update:  Lets start with the good news. Mother did finally get her c-section.  Both mother and baby survived the experience.  Ummmm, I think that is about where the good news ends. Keep praying.  Mother responded very poorly to anesthesia (general, not spinal). First under anesthetized, then way over. Now, out of her mind. Kicking, hitting, biting. She has pulled out two IVs and her foley. The baby was next to her on the bed for a few minutes and she almost successfully threw it on the floor. Baby is doing slightly better than her mother but also needed serious resuscitation (possibly for the same reason her mother did?!) Tiny little girl. Weighs four pounds. She can't seem to keep her body temp up and power is off so they aren't putting her in an incubator but at least now her sats are holding. We have not successfully gotten Retrovir  (infant antiretroviral prophylaxis) because it is the weekend, but hopefully tomorrow. 
This is baby girl with her grandmother. 

Mother after we had to knock her back out to keep her from hurting herself and us. 


My sediments exactly, kid!

Friday, May 12, 2017

Topping today's playlist.....

Listening to this today. Mercy Me- Even If


I'm stuck at home because my truck is back at the mechanic. So I decided to re-grout the tiles in my kitchen. Though that implies that they were grouted when I moved in. They were not. Just packed with clay. Which is really gross when kneading bread, rolling out pie crust, really anything that touches the cracks between the tiles. So I used a screwdriver to scrape out all the clay and started over. I'm rather pleased with the end result.

Monday, May 8, 2017

Some days are just... rather disagreeable. (I'd like to say just suck but I'm a missionary so I probably shouldn't say that.)

I know it happens all the time and it isn't that big of a deal but it is still a let down when it happens. I had a primigravida mom laboring in the clinic today. She came in late last evening and the midwife was up off and on with her in the night. Around six am her labor stepped up, so by the time I arrived at eight the midwife was ready for a few hours off. I could understand why. The mom was laboring well but needed quite a bit of support. Which is actually a bit unusual for women here, as they tend to labor alone without much intervention. This mom was needier but I don't mind it as it is more of what I'm used to, so I willingly took over. However, there were also 20+ prenatal cases to see. (I totally lost count but finished off a new 500 tablet container of prenatal vitamins early in the morning and at 30 tabs per mother that is at least 17 women that I saw before 10am.)  The  mom was having strong contractions and not handling the pain well but was up moving around and dilated several cm between when I arrived and late morning so I thought we were doing well, except the head was poorly engaged.   We tried lots of different tricks and everything else was fine so it just seemed like we were in for a long labor. Besides, it was taking me forever to get through all the other patients so I was going to be around the clinic for most of the day.  I was checking  FHTs often and initially I would have charted good variability (not that there is any charting here) however by one pm possibly they could have been called variable decelerations but really they were on the way to late decels. Without an actual tracing it was hard to call it but it didn't feel right. And the mother was weary and fully dilated and the head was still high. I was in the midst of discussion with the midwife when we had a snake bite patient come in that kept us all tied up for a while.  Then when I slipped back into the labor room in the midst of a really strong contraction and put the doppler on it barely registered 90bpm, so our decision was made. The good news was in the process of getting her up (leaking amniotic fluid all over the place) and loading her in my truck (that is going to smell nice for a few days) the heart rate came back up.  We made the 20 minute trip into town and I unloaded her directly into L&D. Technically we're supposed to register and crap first but there are a few perks to bringing in more than twenty patients per month. The staff really snapped to and patient was headed to surgery shortly thereafter.

Little side antidote, I usually use the clinic delivery stuff when doing it there but I also carry a delivery kit for home/side-of-the-road stuff. Today I cracked open my own kit because the clinic midwife was sleeping and I couldn't find some of the supplies that I wanted.
I tossed a disposable chux under the patient. (Every american nurse knows what I'm talking about but for you non hospital people it is this thing. We use them for any and every leaking fluid. As a matter of fact, even if you aren't leaking anything, but might be in the future, you get one tucked under you somewhere.) Well, the clinic staff went nuts. They think this is possibly the best medical innovation ever. Now, I've given them a doppler, an autoclave, a BVM, an obstetric calculator, and a variety of other things to make their lives easier. This one takes the cake for them though. They have requested a carton. I had to sadly explain that I only have three left and I am saving them for emergencies.
In other news on this lovely Monday, my dog has been missing for three days and is presumed dead. It seems that no amount of attempted bribery of the neighbor kids is going to bring him back this time. Also, one of the secondary school kids that I sponsor got really good marks this term and I had promised if he got Division 1, I would get him into a better school. He really impressed me with his hard work, so early this morning he was over to get the necessary requirements to transfer. Then he proceed to steal 300,000 shillings when he though I wasn't looking. This like three months wages for many people here. This is the third time he has been caught stealing from me. (How many times have I not caught him?!?) So we are done. Completely. What he stole was less than half what I would have paid in school fees for him next term so I can't figure out what he was thinking. More than anything else it makes me sad because he has such potential. But lets be honest, it also makes me pissed off. Oh, that seems like another thing missionaries shouldn't say.


Thursday, May 4, 2017

Mango season and medical pictures


There are thousands of pounds of mangoes just dropping off the tree and rotting right now, so this week Christina and I showed several people how to preserve them. We peeled, cut and dried several full basins of mangoes.



Also, completely unrelated, but because I'm pulling pictures off of my camera.....
I'm getting much faster at suturing. Now you no longer need to chose between quick or neat. Possibly you can have both if, like this young man, your bull's horn catches the inside of your arm. 

Also, I've put on my first hip spica cast. This is mid way through the process and after my patient received a dose of morphine.  


Also, I have a little guy with clubfoot who is almost finished with his casts.

Sunday, April 23, 2017

Alcohol

So some fellow missionaries shared this video that gives a good look at the problem of alcoholism in Uganda. The language in the video isn't great but it is a pretty accurate portrayal of the issue.  My chief complaint about it is that he doesn't actually get very far out of the urban area. If he had he might have found that people use the booze as food instead of with food. And in Karamoja the kids are often fed the dredges of making the alcohol. I still recommend watching.

Video

The missionaries who posted this also discussed why chrisians don't drink at all here. Also worth the time. Their blog (also with the video)  here.

Saturday, April 22, 2017

There, I said it.

God fixes thing right? I know He can. God intervenes in people's lives. He can. He has the power to do the miraculous. Sometimes He chooses to.  And it hurts so much when He chooses not to. I trust you Lord. You can fix and heal and mend and set right. But then you don't. And this erodes my hope and confidence. And it hurts. It becomes easier not to hope and just stop praying that He'll fix it.But then what?


Friday, April 21, 2017

Islands of Hope

Carrying clinic tables
Setting up. 
I spent the past three days on the islands in Lake Victoria helping another mission team with their medical outreaches. Here are just a few pictures. 



HIV testing


Several hour commute in this little boat on a very big lake. Notice the guy in the back right baling water....

More pictures


Drying fish





Sunday, April 9, 2017

Earth has no sorrow that heaven can't heal

It's Sunday afternoon, trying to get ready for the coming week.... Truthfully, this past week wrung it out of me. Two miscarriages at the clinic due to malaria. Told two different ladies that they had cancer. Frustrated with the poor quality care at the hospital. Lots of home visits for the sick and in the village the hunger and food shortage is astounding. People are literally starving. Especially affected are the elderly and chronically ill. We visited an elderly couple who together might have tipped the scale at 100 pounds. We brought them rice and chicken broth and they literally licked the bowls. The rains should be started by now so there should at least be a few fresh things to eat and hope for the coming months but it is still stunningly hot and dry.

So, now just sitting quietly, asking for fresh joy for the week. I profess to having a hope that unbelievers don't have. So no matter how depressing, discouraging, frustrating or pointless the day feels I have something to share.

Found encouragement in this one tonight. Listen

Friday, April 7, 2017

Really, is that all?!

My eighth April in this country.....

Thursday, March 30, 2017

Witchcraft, curses and babies

I'm really not sure how to write about this one
​, b
ut it is something I've been thinking and praying
​ a lot​
 about 
​​
lately. I'm sure if I'd written this eight years ago it would have come out much differently but I've seen and heard s
​o much​
 since moving here. 
 
  • Last week I was told a terrible account of a body of a young child found beheaded right outside of Soroti town. He had been killed in witchcraft in order for someone to obtain a "blessing". 
  • A few months back I was praying with a woman who knew she was an alcoholic and wanted Christ in her life but had been told that she couldn't. This woman had recently lost two children to what she believed were curses. She didn't tell me illness or accident had taken their lives but was very specific and firmly believed that it was witchcraft. I didn't argue with her, just prayed and asked that the God of Truth clear her mind, bring right thinking and also release her from the alcohol that feels like an escape but is actually a trap. 
The most recent event that his brought this topic to the fore is Judith's (her story yesterday) concern that a curse killed Anna. While sitting at the hospital, waiting for the death certificate, scant hours after Anna's death, Judith leaned close to me and in a s
urreptitious whisper told me she was afraid a "big man" (meaning wealthy man of some social standing) in the community wanted her baby's life. A friend at church had told her that she had a dream that this man was trying to steal the baby. Anna fell sick that same day. Judith realized that some of Anna's clothes had been stolen
​,​
 too. Then, suddenly when it looked like she was getting better the baby died. Anna had a strange choking episode (as her mother described it) and never breathed for herself again then died within the hour. Her mother added all this up and concluded that it was a powerful curse that took her daughter's life.
 
Now, this is a 
​C​
hristian, 
​B​
ible
​-​
believing, church
​-​
attending woman! 
 
​​
First off, how do I respond? Pre-africa me would have been quick to reassure her that this was crazy thinking and there was a clear medical reason for her death and that curses are not real. I still believe there might be an explainable medical reason why she fell sick initially then stopped breathing but I no longer believe this stuff of witchcraft is a figment of active imaginations. Is it something to point to when grieving mothers want something to blame?  Maybe. But is there something more?
 
I've come to believe
​ that there is demonic 
power that we in the western world like to ignore. The 
​B​
ible references it too many times for sorcery and witch craft to be a pretend thing. I still firmly believe we children of God are safe as we are covered by the blood of Christ. But are there some sins that open us up to the influence of satan?  Do witch doctors really receive favors when being obedient to evil? Are innocent lives lost when people make terrible choices?  We know it happens. 

I'm going to visit Judith again today, about a week from the death of her only child
​, w​
ho
​m​
 she fears was taken by evil forces
​, ​
I want to reassure her with the promises of God. I want to speak only Truth. I want to bring peace. 
​​
What should I say?

Lord God, One could say that you also lost your only child to evil forces. But you didn't, not really. You released him and allowed satan to do his worst. But you still triumphed. So we call on that name right now. The name of the one that overcame all that evil and darkness. 
As we sit with Judith, help us to share your peace. Let us not share what we think is true but let us share only what is really Truth. May be bring a little love and comfort in this hard time. Amen. 

Tuesday, March 28, 2017

Last post about baby Anna

I have some terrible news. Most of you regular readers remember baby Anna born in November?  She was still waiting for her permanent VP shunt surgery and her cleft lip surgery. She fell sick two weeks back and after fighting an unknown illness passed away 4 days ago.   We admitted her to Bethesda on Friday the 17th due to extreme dehydration and high fevers. After spending all weekend there with no improvement (and practically no medical care! but that is a rant for another post...) I got very assertive on Monday morning before clinic.  The nurses did step it up a bit and by midday they had attempted several IV lines and the lab was working on some stuff but really we weren't any further than on Friday evening so I packed up mom and baby and got them to the neuro hospital in Mbale where she was directly admitted to the ICU. I never heard if they got a dx but heard from her  mother that she perked back up quickly and was moved back to the general ward after one day. She was starting to act like her normal self and they were getting ready for discharge. Then suddenly we got a call early morning of the 24th that she had been put on a vent. An hour later we got a second call that she had died. 
Mom and I scrapped all our plans and headed to Mbale. This is a village family with no means to transport a body home so we went to go be with Judith and also help in this way. 
About midday when we pulled into the rural home where the baby would be buried the family was already starting to gather to mourn with her. 
Thank you to all who prayed for her. Please keep praying for this mother who has just lost her only child. 

The parent's trip

So my mom and dad left late last night for the airport. They said goodbye to the kids in the evening as they tucked them into bed. I cried all over again when this morning, after I arrived back at Benj and Christina's house, Ellie asked me why Grandma and Grandpa didn't come back from the guesthouse with me.
We had a great time doing fun stuff like two nights on an island on the Nile. And playing hours of Legos and barbies. The adults played hours of card games and board games. (Our current favorites are Castles of Mad King Ludwig and 7 Wonders, both of which I highly recommend.)
But don't worry, it wasn't all fun and games.













We also made them work very hard. Mom and I packed birth kits and I made her work two shifts in the clinic. We even had a laboring mother and could have done a delivery but everyone (my mom included) decided it was better if we just brought her to the hospital. We spent several hours making 34 jars of salsa and prepared several meals for my freezer.

Dad spent hours welding, mixing cement, digging holes, hanging lights, rewiring several things, fixing door frames, knocking out walls and hanging a hammock.
Mom and Dad also both preached on Sunday.















The highlight of my mother's trip was going to the Jinja Snake park. (Actually we dragged her along kicking and screaming.) See this weak little fence and small piece of plywood between them and this 650 kg/ 1000+ lb monster?  This is only one of many reasons she didn't want to go. Ellie was most interested in the donkeys and Grandma was OK with that. 


Overall it was a really nice time and was over far too soon.